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The use and non-use of assistive technology in Italy: Preliminary Data

Authors:

Abstract

Purpose: The present pilot study aims to analyse the relationship between the reasons of the use/non-use of assistive technology (AT) and levels of user satisfaction of Italian user/patient in order to identify which features of the Italian AT assessment process in the Italian Territorial Health Service Providers (THSPs) better predict AT non-use. Method: Between November 2010 and January 2011, a telephonic structured interview with open- and closed-ended questions was administrated to 104 THSP users who have received an AT at least one year before. Results: Findings show that there is a 25% of AT non-use that is strictly related to the user satisfaction of AT and to the lacks percept by the users in the assignation process. personal opinion considered in selection.
The Use and Non-use of Assistive
Technology in Italy: Preliminary Data
Stefano FEDERICIa,1 and Simone BORSCI
a
a
Department of Human and Education Sciences, University of Perugia, Italy
Abstract
Purpose The present pilot study aims to analyse the relationship between the
reasons of assistive technology (AT) use/non-use and the levels of user satisfaction
of Italian users/patients in order to identify which features better predict AT non-
use in the Italian Territorial Health Service Providers (THSPs) AT assessment
process.
Method Between November 2010 and January 2011, a telephone structured
interview with open- and closed-ended questions was administrated to 430 THSP
users/patients who have received a hearing aid or a stairlift at least one year before.
Results Findings show a 25% of AT non-use and a strong correlation (p<.001)
between AT non-use and the AT users/patients’ dissatisfaction reasons –
adjustments and personalisation, safety, and comfort. Of particular interest is the
fact that users/patients tend to not use the AT if the follow-up provided by the
THSP is dissatisfactory. A strong correlation (p<.001) is also founded among the
AT satisfaction, measured by the QUEST 2.0, and some reasons of non-use; the
users, indeed, claimed that they are likely to not use the AT when they are not
satisfied by: i) The AT dimension or the weight, since it was hard to make it work
and it did not help users/patients to perform better; ii) The AT personalisation,
since they had to require more assistance than was really necessary and the AT did
not help them to achieve their goals; iii) The AT safety, since users/patients had to
spend a lot of energy using the AT, so involving other people (caregivers) who
complained about the AT; in other cases, conversely, the safety dissatisfaction was
linked to a low degree of transportability and storability of the aids; iv) The AT
simplicity of use and effectiveness, since the AT did not help users/patients to
perform better; v) The AT comfort, since AT required a lot of training and
assistance in use, did not help to achieve users/patients goals, was not comfortable
and/or was difficult to wear.
Conclusion Our data clearly show that the users’ satisfaction of AT and of service
providers are strongly correlated to the AT non-use, by suggesting that just a user-
driven process of AT assignation process, centred on the user/patient needs and
expectations might reasonably prevent the AT non-use and abandonment. The
25% of AT non-use estimated in this survey is slightly lower compared to the
range of percentages usually reported by international studies that is rated from
29% to 33%. Albeit our findings suggest that there is a lower percentage of non-
use than in other health systems, the AT non-use level remains high (about one
quarter of the ATs assigned are not used), becoming a significant economic loss
for the Italian National Health System.
Keywords. Assignation Process, Assistive Technology Assessment, Non-use and
abandonment, QUEST 2.0, User-Centred Design, Satisfaction, National Health
Systems.
1 Stefano Federici email: stefano.federici@unipg.it.
Everyday Technology for Independence and Care
G.J. Gelderblom et al. (Eds.)
IOS Press, 2011
© 2011 The authors and IOS Press. All rights reserved.
doi:10.3233/978-1-60750-814-4-979
979
Introduction
Assistive Technology (AT) plays a key role in facilitating the social integration and
participation of people with physical, sensory, communication, and cognitive
disabilities. The process of matching AT and person requires a well-designed and
researched sequential set of assessments administered by professionals with different
areas of expertise: the success of the matching is determined by the evaluation
protocol/model and by the skills of the multidisciplinary team members. In Italy and
other countries, matching may be provided primarily by centres for technical aids,
where a team of experts connects the person with a disability and one or more AT
devices.
In Western countries that process is characterised by two apparently opposing
models: in one of them, the most widespread in Italy and other European countries, the
person who requires an aid is considered to be a user/patient of a public health system;
in the other one, more widespread in English-speaking countries (e.g. USA), the person
with a disability may be viewed more as a customer of a private/non-national health
system. In the first case, the centre does not sell products but provides evaluation
services and aids to users/patients2; in the second case the centre for technical aids may
also sell the technological aid provided. The first model guarantees more professional
neutrality in assessing and matching technology; the second model favours user-
centred satisfaction with the product found to be a good match.
Nowadays, there are no studies that have analysed the differences in the AT
use/non-use between users of private/non-national health systems and those ones of
national health systems. On this particular issue there are no Italian assessment
published studies3. Anyway, well-known international studies on abandonment in
private/non-national health systems [1, 3, 6–9, 13, 15–19] agree on abandonment equal
to about one-third of the assigned devices. These data point out users’ widespread
dissatisfaction and frustration, probably because the user did not find facilitated his or
her performance.
1. The Matching Aid and Person project
Our study presents preliminary data of a research project entitled Matching Aid and
Person (MAP), financed by the Umbria Region in 2009. The MAP project aims to
identify the percentage of AT non-use and the users’ satisfaction of AT in a national
health system in order to check the quality of health service provide by the Umbria
Region to residential citizens and prevent waste of public money. The development of
the MAP project is based on the proposals of the Umbria Regional Health Plan 2009–
2011 [12], in which the need of improving the service quality and the users’
satisfaction have been declared, reducing the risk of abandonment and the consequent
waste of public resources. This goal can be obtained only by improving communication
and sharing of expertise among the Territorial Health Service Providers (THSPs),
building up a best practice guide. The MAP project is structured on a “User-Centred
2 For the sake of brevity we use, from now on, just the term ‘user(s)’ instead of ‘user(s)/patient(s)’.
3 Only one unpublished Italian report on aids-use rates a 37% of abandonment. The report dated 2001,
concerning the abandonment of devices in Piedmont, indicates the percentage of abandonment without
discussing the methodology and the data recruited.
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Design” ergonomic approach suited on the biopsychosocial model of disability that
complies with the request and the need of disabled people of “nothing about us without
us” [2]. The Umbria Region declares [11] a strong diversity of the care and
organisational models and of the therapeutic pathways among the THSPs, which
inevitably affects the processes for the assignment of assistive tools to disabled people.
This non-homogeneity of organisational models is associated with a lack of planning
and optimisation of the assignation process, showing also a delay in revising the
models that are not user centred. These factors, usually, show a high correlation with
the abandonment and non-use of ATs, with a consequent waste of resources and a high
users’ dissatisfaction; thus failing the aim stated in the Regional Plan to “encourage the
disabled people in the achievement of the best possible activity and participation” [12].
The MAP project aims to make clear not only the model of the assignment process and
specifically how much that model takes into account human needs and satisfaction, but
also the amount of AT that would be available for their reuse into the virtual cycle of
health for the benefit of other users. The MAP project pursues two main goals: i) the
first one aims to design, analyse and compare the regional THSP assignation processes
in order to build up a best practice guide able to unify and standardise the different
kinds of assignation process. The MAP team has used the ideal model of AT
assignation process described by Scherer and Federici [14] as criterion to compare and
evaluate each THSP of the Umbria Region. This analysis is still going on; ii) the
second one aims to analyse, by a user-centred perspective, the relation among the
assignation process, the satisfaction and the non-use of the AT. The present study is
focused on the second aim of the MAP project.
2. Materials and methods
Between November 2010 and January 2011, a telephone structured interview with
open- and closed-ended questions was administrated to 430 THSP users who have
received an AT at least one year before.
2.1. Tool
A user/patient evaluation of use of and satisfaction with AT survey questionnaire was
developed by using some of the questions of the Philips and Zhao’s Abandonment
Survey Questions [10], the entire Quebec User Evaluation of Satisfaction with
Assistive Technology (QUEST 2.0) [4, 5] and by creating new questions about
demographic user data and the evaluation of all services provided by the THSP. The
survey questionnaire, so composed, is a structured interview with open- and closed-
ended questions in four sections, as described in the following list:
Anamnestic – section 1: composed of eight questions; the main goal of this section
is to identify who answers the questions (the user, the caregiver, or the user and the
caregiver together), and the kind of AT.
National services evaluation – section 2: composed of five questions; this section
aims to obtain a global evaluation of the i) THSP office for assignation; ii) general
health care services provided by the THSP; iii) the time perceived by users spent
obtaining the AT; iv) the number of steps perceived by users obtaining the AT; v)
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the bureaucracy perceived by users in the process. Each question is a 5-point likert
scale from 1 (not satisfied at all) to 5 (very satisfied).
Users’ satisfaction with AT – section 3: composed of a QUEST Italian version 2.0
[4, 5]. The QUEST can be used as a self-administration questionnaire or as an
interview, with the response categories ranging from 1 (not satisfied at all) to 5
(very satisfied). The QUEST scores can be analysed by three scales: Device (from
Q1 to Q8), Services (from Q9 to Q12), and a Total score. All scores are calculated
by summing and then averaging valid responses to assigned items [4, 5].
AT non-use – section 4: composed of 17 questions (from A1 to A17), this section
is administrated only to the users that declared the abandonment of the AT. For the
interview on the abandonment, we selected among the 30 questions used in the
study of Philips and Zhao [10], the 23 that those authors have indicated as the
questions that have obtained the most number of answers, in their study, by the
users. We also excluded six questions indicated by Philips and Zhao from our
survey on abandonment, because they are contained (implicitly or explicitly) in
other sections of the global survey (Table 2). All these questions have three
options of answers: Yes, No, I do not know [10] except for A15 (How long
have/did you use AT?) that is expressed by four time options.
The survey questionnaire was administered through a telephone interview to 430 THSP
users who have received an AT at least one year before. The list of participants was
provided by the THSP subject to the agreement between the Department of Health of
the Umbria Region and the Department of Human and Education Science of the
University of Perugia.
2.2. Participants
A database of 430 participants was provided by the THSP with users who have
obtained a hearing aid (HA) (355) or a stairlift (SL) (75) at least one year before the
survey. One hundred and four participants (25 male, 79 female) accepted to respond to
a telephone interview with a response rate of 24.1%, of whom 81 (77.9%) obtained a
HA and 23 (22.1%) have obtained a SL. Data about AT users was provided via
telephone by the users themselves alone (25%; M of AT users age=72.5; SD=16.2); or
by the user with the help of third-party, e.g. family members or caregivers (2%; M of
AT users age=77.3; SD=12.7); or third-party alone, e.g. family members or caregivers
(73%; M of AT users age = 78.5; SD=12.1).
2.3. Data analysis
Initially, descriptive analyses (Mean [M], Standard deviation [SD]) were conducted to
explore the features of the sample. Psychometric properties of reliability and validity in
the QUEST 2.0 Italian version were then assessed. The correlations among the
subscales of the QUEST and the scores of the section 2 (national services evaluation)
and the section 4 (non-use of AT) of the survey questionnaire were calculated by
Pearson’s correlation coefficient. A sufficiently high score indicates that users’
satisfaction correlates with AT non-use reasons. Data were processed using the
software IBM® PAWS Statistics18.
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3. Results
3.1. Users’ evaluation of national service and user satisfaction
The users’ evaluation of the national service (survey section 2) shows that 70.6% of the
users are satisfied with the service provided by the HTSP (51.9% quite satisfied, 11.5%
very satisfied), albeit the 29.4% of the participants claimed that they are more or less
satisfied 11.1%, not very satisfied 12.5%, or not satisfied at all 5.8%. The analysis of
users’ satisfaction with AT (section 3) obtained by the administration of the QUEST’s
total scores shows that the global score for the HAs’ satisfaction (M=4.08, SD=.81) is
less than the satisfaction of the users that have received a SL (M=4.43, SD=.87).The
level of users’ satisfaction that have obtained HAs is decreased due to low scores (but
sufficient) of satisfaction for the services provided by the HTSP (M=3.19, SD=.86).
The different levels of satisfaction are clearer when we analyse the satisfaction
percentage declared by the users in each question of the QUEST. Overall, users have a
good level of device satisfaction (from Q1 to Q8), with some problems with the safety
(Q4) of the AT, particularly for HA users who declared a 38.3% of dissatisfaction,
while SL users are dissatisfied for 17.4% of the cases. A durability problem is evident
for the HA users who are dissatisfied for 19.8% of the cases (Q5); at the same time,
these users show a high dissatisfaction also for the comfort (Q7) and for the
effectiveness (Q8) of the AT. A higher degree of dissatisfaction is declared by the HA
users than the SL ones: 21% of the HA users are dissatisfied with the comfort and 37%
with the effectiveness, while the SL users declared a dissatisfaction of 17.4% for the
comfort and 13% for the effectiveness. The analysis of the QUEST’s questions from
Q9 to Q12, concerns the users’ satisfaction of the service offered by the THSP in
providing the AT. This analysis shows that there is a very high degree of dissatisfaction
with the THSP service delivery (Q9), particularly 83% of users declared that the
problem is the time spent obtaining the AT (25.9% for HA users, and 34.8% for SL
ones). A warning level of users’ dissatisfaction also concerns both the professional
service (Q11) and the follow-up (Q12) which respectively have obtained a
dissatisfaction degree equal to 14.8% (HA) and 13% (SL) for the professional service,
and 13.6% (HA) and 21.7% (SL) for the follow-up.
The correlation between national service evaluation (survey section 2) and the
users’ satisfaction with AT (survey section 3) is analysed by the Pearson’s coefficient.
This analysis shows a good correlation between the national service evaluation and the
following questions that composed the QUEST’s device satisfaction scale: the weight
of the aids (Q2; r=.201, p<.05), the easiness of adjustment of the aids (Q3; r=.206,
p<.001), the simplicity of use (Q6; r=.206, p<.05), the comfort (Q7; r=.245 p<.05) and
the effectiveness of the aid (Q8; r=.239, p<.05.).
At the same time a very strong correlation (p<.001) is shown between the
evaluation expressed by users in the section 2 and all the questions that composed the
scale service of QUEST (from Q9 to Q12).
3.2. Users’ satisfaction and users’ non-use
The analysis of the non-use of AT (section 4) shows that there are 25% of AT non-use
in the THSP and a strong inverse correlation among the users’ AT non-use and section
3 (Table 1).
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Table 1. Pearson’s correlation index between the non-use of AT (section 4) and the QUEST scales ‘Device’
and ‘Service’ (survey section 3). Significant correlations are found within the scale ‘Device’ – Adjustments
(Q3), Safety (Q4), Comfort (Q7) – and ‘Service’ – Follow-up (Q12).
Q3 Q4 Q7 Q12
AT Non-use -.194* -.275** -.207* -.225*
*The correlation is significant at level .05; **The correlation is significant at level .01.
The results show that unless the user is satisfied with AT adjustment (Q3), safety
(Q4) and comfort (Q7), the more likely he or she does not use technology. At the same
time an important role in the use/non-use of AT is played by follow-up service. The
percentages of the different reasons that contribute to the AT’s non-use (survey section
4), are shown in Table 2, excluding from the analysis the question A15 (How long
have/did you use it?) which provides answers in the scale of time.
Table 2. Frequencies of users’ responses to the optional survey on the reasons of AT non-use.
Yes No I do not know
A1 – Was it easy to obtain from the supplier? 65.4% 30.8% 3.8%
A2 – Did the installation/assembly require a lot of work? 69.3% 26.9% 3.8%
A3 – Did you require more than 2 hours of training in AT use? 46.2% 46.2% 7.6%
A4 – Is/was it easy to make AT work? 46.2% 53.8%
A5 – Do you require assistance in using the device? 69.2% 30.8%
A6 – Did/does the AT always work? 42.4% 53.8% 3.8%
A7 – Did/does the AT help you perform better 38.5% 61.5%
A8 – Was/is the AT comfortable? 38.5% 57.7% 3.8%
A9 – Was/is the AT safe to use? 53.8% 46.2%
A10 – Did/does it demand a lot of energy/time to use (self)? 27% 61.5% 11.5%
A11 – Did/does it demand a lot of energy/time to use (others)? 15.4% 65.4% 19.2%
A12 – Did/do others complain about the item? 15.4% 76.9% 7.7%
A13 – Was/is it easily transportable? 80.8% 15.4% 3.8%
A14 – Was/is it easily stored? 80.8% 15.4% 3.8%
A16 – Did/does it wear well? 34.6% 50% 15.4%
A17 – Have your needs changed? 42.3% 57.7%
A great level of correlation is shown among the questions of QUEST (survey
section 3) and the reasons of non-use gathered by section 4 (Table 3).
Table 3. Pearson’s correlation index among the QUEST items (survey section 3) and the reasons of AT non-
use (survey section 4). Seven items of QUEST (Q1, Dimension of aid; Q2, Weight of aid; Q3 Adjustments;
Q4, Safety; Q6, Simplicity of use; Q7, Comfort; Q8, Effectiveness), show a correlation with one or more of
the following reasons of AT non-use: A3 – Did you require more than 2 hours of training in AT use? A4 –
Is/was it easy to make AT work? A5 – Do you require assistance in using the device? A7 – Did/does the AT
help you perform better? A8 – Was/is the AT comfortable? A11 – Did/does it demand a lot of energy/time to
use (others)? A12 – Did/do others complain about the item? A13 – Was/is it easily transportable? A14 –
Was/is it easily stored? A16 – Did/does it wear well?
Q1 Q2 Q3 Q4 Q6 Q7 Q8
A3 -.652**
A4 -.408*
A5 -.490* -.423*
A7 -.802** -.802** -.415* -.414* -.436* -.610**
A8 -.437*
A11 -.452*
A12 -.692**
A13 .453*
A14 .453*
A16 -.617**
*The correlation is significant at level .05; **The correlation is significant at level .01.
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Our data clearly show that a good assignation process, favoured by a user-centred
design and focused on the users’ needs is strictly related to AT user satisfaction and aid
use/non-use. The relation between the satisfaction and the reasons of non-use is very
strong, as it is shown in Table 2. The users claimed that they are likely to not use the
AT when they are not satisfied with the following AT features:
Dimension (Q1) or weight (Q2): in this case users claim that it is hard to make AT
work (A4) and/or AT does not help them to perform better (A7).
Personalisation (Q3): in this case users have to require more assistance to use the
AT than is really necessary (A5) and, also, the AT does not help them to achieve
their goals (A7).
Safety (Q4): in this case users declare to spend a lot of energy in order to use the
AT assigned (A11), involving other people (caregivers) and, in their turn, also the
caregivers themselves complain about the AT assigned (A12). At the same time,
the safety dissatisfaction could be also linked to a low degree of transportability
(A13) and storability of the aids (A14).
Simplicity of use (Q6) and effectiveness (Q8): in this case users affirm that the AT
does not help them to perform better (A7).
Comfort (Q7): in this case users complain about a lot of training (A3) and
assistance in use (A5) required for the AT use. Moreover, the AT does not help
users to perform better (A7), it is not comfortable (A8) and/or difficult to wear
(A16).
4. Discussion
Our preliminary data shows an abandonment of 25% of AT. This percentage is lower
than the percentages usually reported in other studies [1, 3, 6–10, 13, 15–19] that range
from 29% to 33%. However, until now, the data are limited to just one of the four
THSPs of Umbria Region and to specific kinds of AT (i.e. HAs and SLs). As Philips
and Zhao, we adopted: “a stringent definition of abandonment that described only one
outcome of a ‘person-technology’ interface. Changes in device brands that do not
represent changes in device categories were not accounted for even though those
changes may have been due to dissatisfaction with the original device” [10]. However
we extend the perspective of analysis introducing both, an instrument for analysing the
AT and service users’ satisfaction (QUEST 2.0) and for the evaluation of the global
service provided by the Italian National Health System in the territory (survey section
2). By using the Philips and Zhao word “This study’s findings suggest that services
designed to involve consumers and accommodate long term technology needs will
enhance consumer satisfaction with AT and reduce device abandonment” [10]. In this
sense our study remarks that just a user-driven process of AT assignation, centred on
the user needs and expectations might reasonably prevent the AT non-use and
abandonment.
Globally, users of public/national health systems declared a good satisfaction level
of the THSP work. However, users complain about three main problems that affect the
THSP service: the long delay in the delivery of the AT assigned, the lack of a follow-
up, and a low professional profile in the technical support. Our results clearly show that
the satisfaction of the users in AT use is linked to the satisfaction of the THSP; indeed,
the correlation analysis shows that the more the users are satisfied about some AT
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features (e.g. weight, easiness of adjustments, simplicity of use, comfort and
effectiveness) the more they are satisfied with the THSP service. At the same time our
findings underline that the less users are satisfied with some AT features (e.g.
adjustment, safety and comfort) the more likely they do not use technology.
The percentage of AT non-use found in this study shows that one quarter of the
assigned AT are not used by the users. Even if this percentage of abandonment or non-
use shows a lower rate compared to findings of international studies, this amount is still
high, becoming a significant economic loss for the Italian National Health System.
Acknowledgement
Funding for the Match Aid & Person project has been provided by the Sanity and
Social Services Department of the Umbria Region in 2009 (DGR 1318/09).
References
[1] C.D. Brand, Availability and Accessibility of the Nation’s Research Infrastructure: The Transfer of
Assistive Technologies by Federal Laboratories, Journal of Technology Transfer 28 (2003), 197-205.
[2] J.I. Charlton, Nothing About Us Without Us: Disability Oppression and Empowerment, University of
California Press, Berkeley and Los Angeles, 1998.
[3] H. Day, J. Jutai, W. Woolrich, and G. Strong, The stability of impact of assistive devices., Disability and
Rehabilitation 23 (2001), 400-404.
[4] L. Demers, M. Monette, Y. Lapierre, D.L. Arnold, and C. Wolfson, Reliability, validity, and applicability
of the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0) for adults with
multiple sclerosis., Disability and Rehabilitation 24 (2002), 21-30.
[5] L. Demers, R. Weiss-Lambrou, and B. Ska, The Quebec User Evaluation of Satisfaction with Assistive
Technology (QUEST 2.0): An overview and recent progress, Technology and Disability 14 (2002), 101-105.
[6] B.P.J. Dijcks, L.P. De Witte, G.J. Gelderblom, R.D. Wessels, and M. Soede, Non-use of assistive
technology in The Netherlands: A non-issue?, Disability and Rehabilitation 1 (2006), 97-102.
[7] A. Kittel, A. Di Marco, and H. Stewart, Factors influencing the decision to abandon manual wheelchairs
for three individuals with a spinal cord injury., Disability and Rehabilitation 24 (2002), 106-114.
[8] A. Lauer, K. Longenecker Rust, and R.O. Smith, Factors in Assistive Technology Device Abandonment:
Replacing “Abandonment” with “Discontinuance”, in: ATOMS Project Technical Report, 2006.
[9] J.A. Lenker and V.L. Paquet, A New Conceptual Model for Assistive Technology Outcomes Research
and Practice, Assistive Technology 16 (2004), 1-10.
[10] B. Philips and H. Zhao, Predictors of Assistive Technology Abandonment, Assistive Technology 5
(1993), 36-45.
[11] Regione Umbria, Definizione delle linee organizzative regionali sulla riabilitazione domiciliare per le
aziende sanitarie locali [Definition of regional organizational guidelines for the of home rehabilitation
provided by local health], in, Regione Umbria, Perugia, IT, 2006.
[12] Regione Umbria, Piano sanitario regionale 2009/2011 [Regional Health Plan 2009/2011], in: D.o.
Health, ed., Regione Umbria, Perugia, IT, 2009.
[13] M.L. Riemer-Reiss and R. Wacker, Factors Associated with Assistive Technology Discontinuance
Among Individuals with Disabilities, Journal of Rehabilitation 66 (2000), 44-50.
[14] M.J. Scherer and S. Federici, eds., Assistive Technology Assessment: A Handbook for Professionals in
Disability, Rehabilitation and Health Professions, CRC Press, London, UK, in press.
[15] M.J. Scherer, C.L. Sax, A. Vanbiervliet, L.A. Cushman, and J.V. Scherer, Predictors of assistive
technology use: The importance of personal and psychosocial factors., Disability and Rehabilitation 27
(2005), 1321-1331.
[16] S. Söderström and B. Ytterhus, The use and non-use of assistive technologies from the world of
information and communication technology by visually impaired young people: a walk on the tightrope of
peer inclusion, Disability & Society 25 (2010), 303 - 315.
[17] R. Verza, M.L.L. Carvalho, M.A. Battaglia, and M.M. Uccelli, An interdisciplinary approach to
evaluating the need for assistive technology reduces equipment abandonment, Multiple Sclerosis 12 (2006),
88-93.
[18] D. Waldron and N. Layton, Hard and Soft Assistive Technology: defining roles for clinicians,
Australian Occupational Therapy Journal 55 (2008), 61-64
[19] Z. Zimmer and N.L. Chappell, Receptivity to new technology among older adults, Disability and
Rehabilitation 21 (1999), 222-230.
S.Federiciand S.Borsci/ The Use and Non-Use of Assistive Technology in Italy986
... In addition to the original French and English versions, the QUEST 2.0 has been validated into languages such as Dutch (Wessels & Witte, 2003), Portuguese (de Carvalho, J unior, Bol ıvar, & S a, 2014), Greek (Koumpouros, Karavasili, Papageorgiou, & Siavelis, 2016), Chinese (Chan & Chan, 2006), and Taiwanese (Mao, Chen, Yao, Huang, Lin, & Huang, 2010). The QUEST 2.0 was also translated into Italian (Portale Siva, n.d.), which has been widely used in different studies (Federici, Meloni, & Borsci, 2016;Federici & Borsci, 2011) but it has not undergone a validation process yet. ...
Article
This study explores validity, reliability, and factor analysis of the Quebec User Evaluation of Satisfaction with Assistive Technology (IT-QUEST) for users of assistive technology devices in an Italian population. It was administered to 75 people to determine which of the 24 original items were relevant to the Italian context using exploratory and confirmatory factor analyses (EFAs and CFAs) were conducted with internal consistency and test-retest reproducibility also evaluated. The EFA and CFA showed that the 24-item survey may have limited relevance to the Italian context. We individuated 12 significative items, divided into two subscales, as well as the original validation. The test-retest showed high values of the Intraclass Correlation Coefficient (ICC) (0.7–0.9), with a 0.812 ICC for the total scale providing support and evidence for Italian professionals to evaluate user satisfaction with assistive technology devices. This research also lays the foundation for developing a validation study of the IT-QUEST 2.0 that is relevant to the Italian culture. Further research may investigate psychometric properties involving more participants and different users of assistive technology devices.
... questionnaire was given to the patients in the Italian territorial health service providers, most assistive technology users reported dissatisfaction with their devices. Usability issues such as simplicity to use, compatibility of the device with the person in terms of size, features and comfort were the primary factors mentioned by the patients for their decision on whether to use or abandon an assistive device (Federici & Borsci, 2011). ...
Thesis
During the design process older and/or disabled adults are often left out of the needs elicitation process because many of the User Centered Needs Elicitation Methods (UCNEM) are not accessible to these individuals. This thesis explains the development of NICKEL, a decision support tool which allows users to determine UCNEMs that fit the human capability of the older and/or disabled adult participants in their study. Three levels of the cognitive, visual, hearing and physical human capabilities required for 19 UCNEMs are determined using a survey and focus group with expert designers/researchers. A user study is carried out to determine the usability and usefulness of NICKEL with novice and expert designers/researchers. Major findings indicated that NICKEL is an easy to use and useful tool for users when determining appropriate UCNEMs for older and disabled adults. Future work could include adding other capabilities such as interpersonal skills and adding new methods to NICKEL.
... Several studies on AT for users with disabilities have underlined that after one or more years from delivery about one third of the technologies provided are likely not to be used for several reasons, such as discomfort, safety, increasing disability, or changes in the people providing care. In addition to these factors, the opinions and attitudes of carers toward the technology are also likely to have a considerable influence [12][13][14][15]. Previous studies in the dementia field have explored carer aspects of AT use, expectations and attitudes [16][17][18]. ...
Article
Full-text available
Assistive technology (AT) can help support the continued independence of people living with dementia, supported by informal carers. Opinions and preferences of informal carers towards a range of assistive and digital information and communication technologies (ICT) to support food purchase and menu selection, including navigation and online shopping, and safe meal-making by individuals living with dementia were investigated. General attitudes and experiences with assistive technologies were first probed by means of a focus group with carers (n = 6), organised through the Alzheimer’s Society in Nottingham, England. A series of AT/ICT product brochures were then produced, describing packages of technologies to enable meal production. Task-specific questions were asked of carers (n = 10) at local Memory Cafés as to the perceived capabilities of each individual for shopping and meal-making. Carers were asked to make pair-wise choices in order to select a personalised brochure and to complete a questionnaire to elicit the practicality, desirability and affordability of specific products and to probe for preferences amongst key features. Opinions on ease-of-use, aesthetics, expected safety-in-use, independence of use and stigma related to the technology packages were also collected. Results showed that carers are able to make detailed choices and express preferences about assistive and digital technologies for the individuals in their care, and customise their enabler package. Most believed that having an enabler package would improve safety. Greater exposure of carers to newer digital products would be beneficial. The brochure method could be employed on consumer websites and by AT assessors. Full article (This article belongs to the Special Issue Smart Health 2016)
... [4,9] However, notwithstanding the positive outcomes of using ATD, many studies show relatively high (25-33%) abandonment or nonuse rates. [10][11][12][13][14][15] In order to understand this paradox, it is necessary to examine disability in its multidimensionality. According to the International Classification of Functioning, a disability is a "result of an interaction between an individual (with a health condition) and that individual's contextual factors (environmental and personal factors)". ...
Article
Full-text available
Purpose: It is widely accepted that social dimensions are crucial when facing a disability. More specifically, a normative incentive to conceal one’s disability, which can lead to abandonment of assistive technology devices (ATD), is often reported. This study seeks to examine this norm. Method: The expected consequences of having a disability were measured using a sample of 549 able-bodied students from three groups. Results: The results showed that the expected consequences of having a disability and therefore the descriptive norms associated with disability were less negative for the participants who were familiar with disability, but higher for sports students. Furthermore, the relation between objective and subjective consequences (having a disability and feeling disabled, respectively) and public and private use of ATD were modelled. The model shows that both higher objective and lower subjective consequences were linked to higher ATD use in public and, indirectly, in private. Conclusion: The present study contributes to the literature on the normative elements related to the use of ATD. Indeed, it shows that when a person makes his/her disability a part of him/herself, she/he is expected to hide it and therefore to avoid using ATD. However, this assessment proves to be context-dependent and calls for the implementation of handicap awareness programs. • Implications for Rehabilitation •If faced with a disability, expecting to feel disabled and expecting lower objective consequences are linked to lower ATD use. •Expected ATD use in private seems to be related to ATD use in public but not to the expected consequences of the disability. •Expectations and therefore social norms about having a disability are highly context-dependent which encourages the implementation of handicap awareness programs.
... This is not just to account for individual differences in sensory modalities, but also user preferences. Assistive technologies are abandoned for numerous reasons, even if a benefit is still provided through use of the technology [39,40,41]. Technological devices that allow for a desirable degree of individual customization, including the ability to operate the device via multimodal means, are likely to be more useful and desirable to users [42]. ...
Conference Paper
In this paper we discuss various navigational aids for people who have a visual impairment. Navigational technologies are classified according to the mode of accommodation and the type of sensor utilized to collect environmental information. Notable examples of navigational aids are discussed, along with the advantages and disadvantages of each. Operational and design considerations for navigational aids are suggested. We conclude with a discussion of how multimodal interaction benefits people who use technology as an accommodation and can benefit everyone.
Thesis
Les personnes en situation de handicap moteur des membres supérieurs ont besoin de système de suppléance pour leur autonomie. Cependant 1/3 de ces aides de compensation sont abandonnées car pas encore suffisamment centrées sur les besoins et les aptitudes de l'utilisateur. La problématique centrale de cette thèse concerne la mise en œuvre d'une méthode de conception centrée utilisateur, adaptée en fonction de la population d'études (personnes en situation de handicap ayant des troubles neuro-moteurs langagiers) pour la conception de trois aides de compensation. La première concerne la commande d'un bras robotique de préhension JACO pour laquelle la conception centrée utilisateur classique a été appliquée. Celle-ci est adaptée pour les personnes pouvant s'exprimer oralement mais qu'en est-il lorsque ces personnes ne peuvent participer directement ou bien ont besoin de leurs aidants pour exprimer leurs besoins ou répondre aux questionnaires? Une alternative est de recueillir les besoins par l'intermédiaire d'experts. Nous montrerons comment la méthode de conception centrée utilisateur a été adaptée pour la conception du système HandiMathKey pour la saisie de formules Mathématiques. Notre dernière adaptation est d'utiliser l'écosystème de la personne comme médiateur pour communiquer et un profil utilisateur. Cette méthode a permis de concevoir l'interface de communication intégrée et de contrôle d'environnement nommée CECI. Nous décrirons également comment la plateforme SoKeyTo permet le prototypage des aides de compensation. Pour chacune des aides de compensation, nous rapporterons les évaluations réalisées et nous discuterons la manière dont la méthode de conception a été adaptée.
Article
The importance of adaptive seating system on body structure and function is widely accepted, but its impact on psychosocial aspects needs more consideration by health professionals. This article describes the Italian validation of the Psychosocial Impact of Assistive Device Scale (IT-PIADS) for non-ambulant people with neuromotor disorders. Once agreement has been given by the original authors, the scale was translated and adapted to the Italian culture. The IT-PIADS was administered to different wheelchairs users with heterogeneous diagnosis. The internal consistency and test-retest reliability were examined. Its concurrent validity was evaluated with the Italian version of the WheelCon-M-SF. The IT-PIADS was administered to 87 subjects. Cronbach’s α was 0.92 (p < 0.05), and the testretest reliability (ICC) for competence, adaptability and self-esteem subscales were 0.96, 0.90, 0.93 respectively. The Pearson correlation coefficient of the IT-PIADS with the WheelCon-M-I-SF scores showed significant data for competence and adaptability subscales. Psychosocial perception on assistive devices can be reliably measure. The IT-PIADS showed good psychometric properties and it is possible to confirm its validity for clinical and research purposes. Nevertheless, before using this measure with greater confidence, further psychometric properties tests of the IT-PIADS are recommended.
Chapter
The present chapter deals with the role and the competencies of the psychologist in a center for technical aid. The lapse of the psychologist’s role in assistive technology (AT) assessment is probably due to the non-coding of personal factors in the ICF. In viewing the psychologist as the “specialist” on personal factors, the authors call for a revision of the ICF, so that in the biopsychosocial model, “psycho” does not continue as merely a prefix. The psychologist in a center for AT evaluation and provision has the goal of supporting the user’s request in the user-driven process, as well as acting as a mediator for users. The psychologist also acts to build a team spirit and enhance the relationship between the client and the home environment. Finally, an original study closes the chapter, focusing on the psychologists’ and professionals’ representations of disabled users and AT.
Chapter
Full-text available
Features Proposes an international evidence-based ideal model of the assistive technology assessment based on experimental research and experiences in assistive products service delivery Brings together in one handbook all the assessment tools needed in an assistive technology service delivery center Describes the professional profiles, skills, and interactions of the multidisciplinary and integrated team members involved in the assessment process Identifies the needed role of professionals of psychotechnology and assessment Reviews all forms of technologies, including recent technologies such as brain–computer interfaces, robotics, and exoskeletons Comes with supplemental material containing the Matching Person and Technology tools in multiple languages. Summary Assistive Technology Assessment Handbook, Second Edition, proposes an international ideal model for the assistive technology assessment process, outlining how this model can be applied in practice to re-conceptualize the phases of an assistive technology delivery system according to the biopsychosocial model of disability. The model provides reference guidelines for evidence-based practice, guiding both public and private centers that wish to compare, evaluate, and improve their ability to match a person with the correct technology model. This second edition also offers a contribution to the Global Cooperation on Assistive Technology (GATE) initiative, whose activities are strongly focused on the assistive products service delivery model. Organized into three parts, the handbook: gives readers a toolkit for performing assessments; describes the roles of the assessment team members, among them the new profession of psychotechnologist; and reviews technologies for rehabilitation and independent living, including brain–computer interfaces, exoskeletons, and technologies for music therapy. Edited by Stefano Federici and Marcia J. Scherer, this cross-cultural handbook includes contributions from leading experts across five continents, offering a framework for future practice and research.
Book
Full-text available
Features Proposes an international evidence-based ideal model of the assistive technology assessment based on experimental research and experiences in assistive products service delivery Brings together in one handbook all the assessment tools needed in an assistive technology service delivery center Describes the professional profiles, skills, and interactions of the multidisciplinary and integrated team members involved in the assessment process Identifies the needed role of professionals of psychotechnology and assessment Reviews all forms of technologies, including recent technologies such as brain–computer interfaces, robotics, and exoskeletons Comes with supplemental material containing the Matching Person and Technology tools in multiple languages. Summary Assistive Technology Assessment Handbook, Second Edition, proposes an international ideal model for the assistive technology assessment process, outlining how this model can be applied in practice to re-conceptualize the phases of an assistive technology delivery system according to the biopsychosocial model of disability. The model provides reference guidelines for evidence-based practice, guiding both public and private centers that wish to compare, evaluate, and improve their ability to match a person with the correct technology model. This second edition also offers a contribution to the Global Cooperation on Assistive Technology (GATE) initiative, whose activities are strongly focused on the assistive products service delivery model. Organized into three parts, the handbook: gives readers a toolkit for performing assessments; describes the roles of the assessment team members, among them the new profession of psychotechnologist; and reviews technologies for rehabilitation and independent living, including brain–computer interfaces, exoskeletons, and technologies for music therapy. Edited by Stefano Federici and Marcia J. Scherer, this cross-cultural handbook includes contributions from leading experts across five continents, offering a framework for future practice and research.
Article
Full-text available
Numerous individuals with disabilities are dissatisfied with their assistive technology and discontinue its use (Phillips & Zhao, 1993). Abandonment rates of assistive technology range from eight percent to 75 percent (Tewey, Barnicle, & Perr, 1994). Factors associated with continuance/discontinuance of assistive technology among individuals who received assistive technology through Colorado agencies (funded under the Technology-Related Assistance for Individuals with Disabilities Act) were investigated. The sample consisted of 115 individuals with disabilities who were provided with funding for 136 assistive technology devices. Independent variables (relative advantage, support, consumer involvement, trialability, changes in consumers, re-invention and compatibility) were examined to determine if they were associated with assistive technology device continuance/discontinuance. Analysis of the results suggests that relative advantage and consumer involvement have a significant influence in predicting discontinuance.
Article
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In affluent societies how people use technology is symbolic of various values and identities. This article investigates the symbolic values and use of assistive technologies from the world of information and communication technology (ICT) in the daily lives of 11 visually impaired young Norwegians. The article draws on a qualitative interview study and employs an interactionist approach. While the use of ICT is found to symbolise competence, belonging and independence, the use of ICT assistive technologies is found to symbolise restriction, difference and dependency. Thus, ICT and ICT assistive technologies have inherently contradictory sets of associations. To fit in as ordinary young people the visually impaired participants reject ICT assistive technologies whenever possible. The partially sighted participants who are somehow capable of participating in online interactions with their peers without ICT assistive technologies reject them. The blind participants, however, do not have the option of participating online without ICT assistive technologies and, consequently, they accept ICT assistive technologies.
Article
Full-text available
. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) is a 12-item outcome measure that assesses user satisfaction with two components, Device and Services. Psychometric properties have been tested with respect to test-retest stability. alternate-form equivalence. internal consistency, factorial composition and nomological validity. Examples of results obtained with the first version of the tool in outcome studies in Europe and North America support the importance and relevance of the satisfaction measure.
Article
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To obtain insight into the prevalence of the non-use of assistive technology in The Netherlands. Relationships between non-use and possible determinants were also investigated. The results of the study might lead to improvement of products and of the service delivery system for assistive technology. A study was performed into user satisfaction and the non-use of 14 categories of assistive technology provided by health care insurers. The design was a survey among a stratified sample of users who had received an assistive device, recruited through a sample of health insurance companies. Two independent samples were selected: one in 2001 and one in 2003. Three aspects of non-use were measured. The total number of respondents was 2272. Ninety-two percent of the respondents used the assistive device at the time of the survey. Less than 1% of the respondents never used the device. A majority of the respondents used the assistive device (about) as much as expected and 6% used the assistive device less than expected. Relationships between non-use and other investigated aspects were found. The average level of non-use of assistive technology found in this study is less than often reported in the literature and varies between the various categories of assistive technology. Improving the quality of the assistive technology and the services, and providing assistive technology that solves the users' problem as much as possible, could enhance the use of assistive technology provided.
Article
Full-text available
Technology abandonment may have serious repercussions for individuals with disabilities and for society. The purpose of this study was to determine how technology users decide to accept or reject assistive devices. Two hundred twenty-seven adults with various disabilities responded to a survey on device selection, acquisition, performance, and use. Results showed that 29.3% of all devices were completely abandoned. Mobility aids were more frequently abandoned than other categories of devices, and abandonment rates were highest during the first year and after 5 years of use. Four factors were significantly related to abandonment--lack of consideration of user opinion in selection, easy device procurement, poor device performance, and change in user needs or priorities. These findings suggest that technology-related policies and services need to emphasize consumer involvement and long-term needs of consumers to reduce device abandonment and enhance consumer satisfaction.
Article
Purpose: Both absolute and relative increases in the older adult population are occurring concurrently with the growth of high technology. Technological devices offer sophisticated solutions to some of the problems associated with ageing. This study borrows from the health utilization literature in order to develop and test a model for understanding receptivity to specific technological products by older adults. Results: Receptivity is directly influenced by predispositional, need and social support factors, as well as by one's level of concern for problems that could be alleviated through the use of technology. Hierarchical regression equations reveal that this latter variable, concern, has the strongest influence on receptivity, while need factors display strong indirect effects. Those with unsatisfactory contact with others are also more receptive, suggesting that the lack of social support acts as a need factor. Contrary to past research, women are more receptive to technology than men. Conclusions: The results indicate that new technology geared toward enhancing the quality of life of seniors in their homes would be welcomed by many.
Article
Both absolute and relative increases in the older adult population are occurring concurrently with the growth of high technology. Technological devices offer sophisticated solutions to some of the problems associated with ageing. This study borrows from the health utilization literature in order to develop and test a model for understanding receptivity to specific technological products by older adults. Receptivity is directly influenced by predispositional, need and social support factors, as well as by one's level of concern for problems that could be alleviated through the use of technology. Hierarchical regression equations reveal that this latter variable, concern, has the strongest influence on receptivity, while need factors display strong indirect effects. Those with unsatisfactory contact with others are also more receptive, suggesting that the lack of social support acts as a need factor. Contrary to past research, women are more receptive to technology than men. The results indicate that new technology geared toward enhancing the quality of life of seniors in their homes would be welcomed by many.
Article
Abandonment of an assistive device (AD) is a frustrating issue yet is very common. An important reason for abandonment is that the device fails to improve the quality of life of the adopter. By means of a new questionnaire, the Psychosocial Impact of Assistive Devices Scale (PIADS) the impact on quality of life of any AD can be measured. This study tested the hypothesis that the impact of the adoption of an AD would wane with time, as the user becomes more adapted to the AD. The study attempted to do a one year follow up on all patients at a leading Canadian clinic who had received first-time prescriptions for eyeglasses. The results showed that the positive impact, present on adoption, did not diminish significantly for those who retained the use of the device. The PIADS provides clinicians with a reliable and economical method for assessing the role of psychosocial factors in the retention or abandonment of an AD.